EURORAD ESR

Case 13432

Post-thrombotic aneurysmal dilatation of the hypogastric vein

Author(s)
Tonolini Massimo, MD; Ippolito Sonia, MD.

"Luigi Sacco" University Hospital, Radiology Department; Via G.B. Grassi 74 20157 Milan, Italy; Email:mtonolini@sirm.org
 
Patient
male, 34 year(s)
 
 
  • Figure 1
    Colour Doppler ultrasound - 5 years earlier
     

    5 years earlier, longitudinal (a) and transverse (b,c) ultrasound images showed chronic deep venous thrombosis (T) of the right lower limb, from the popliteal to the common femoral vein.

     
    Area of Interest: Veins / Vena cava; Imaging Technique: Ultrasound-Colour Doppler; Procedure: Diagnostic procedure; Special Focus: Aneurysms;

    5 years earlier, longitudinal (a) and transverse (b,c) ultrasound images showed chronic deep venous thrombosis (T) of the right lower limb, from the popliteal to the common femoral vein.

     
    Area of Interest: Veins / Vena cava; Imaging Technique: Ultrasound-Colour Doppler; Procedure: Diagnostic procedure; Special Focus: Aneurysms;

    5 years earlier, longitudinal (a) and transverse (b,c) ultrasound images showed chronic deep venous thrombosis (T) of the right lower limb, from the popliteal to the common femoral vein.

     
    Area of Interest: Veins / Vena cava; Imaging Technique: Ultrasound-Colour Doppler; Procedure: Diagnostic procedure; Special Focus: Aneurysms;

    Additional findings included several bilateral inguinal reactive adenopathies (thin arrows in d), and lymphedema of the subcutaneous fat (calipers in e) along the right thigh.

     
    Area of Interest: Vascular; Imaging Technique: Ultrasound-Colour Doppler; Procedure: Diagnostic procedure; Special Focus: Aneurysms;

    Additional findings included several bilateral inguinal reactive adenopathies (thin arrows in d), and lymphedema of the subcutaneous fat (calipers in e) along the right thigh.

     
    Area of Interest: Veins / Vena cava; Imaging Technique: Ultrasound-Colour Doppler; Procedure: Diagnostic procedure; Special Focus: Aneurysms;
     
     
  • Figure 2
    Unenhanced and postcontrast multidetector CT
     

    Axial unenhanced images (a,b) showed a well-demarcated ovoid mass lesion (*) measuring 4.5x3 cm, with solid-type attenuation (30-35 Hounsfield units) abutting the right obturator muscle and compressing the urinary...

     
    Area of Interest: Veins / Vena cava; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Aneurysms;

    Axial unenhanced images (a,b) showed a well-demarcated ovoid mass lesion (*) measuring 4.5x3 cm, with solid-type attenuation (30-35 Hounsfield units) abutting the right obturator muscle and compressing the urinary...

     
    Area of Interest: Veins / Vena cava; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Aneurysms;

    The mass lesion (*) did not enhance in the arterial phase and did not appear to infiltrate adjacent structures. Note extrinsic compression on urinary bladder (+).

     
    Area of Interest: Veins / Vena cava; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Aneurysms;

    The venous phase acquisition (d-h) showed the lesion (*) to enhance homogeneously and synchronously with venous vessels, consistent with aneurysmal dilatation of the proximal hypogastric vein. Urinary bladder (+).

     
    Area of Interest: Veins / Vena cava; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Aneurysms;

    The venous phase acquisition (d-h) showed the lesion (*) to enhance homogeneously and synchronously with venous vessels, consistent with aneurysmal dilatation of the proximal hypogastric vein. Urinary bladder (+).

     
    Area of Interest: Veins / Vena cava; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Aneurysms;

    Coronal (f) and sagittal (g,h) reconstructions confirmed aneurysmal dilatation (*) of the right hypogastric vein without signs of thrombosis. No abnormal dilatation, compression or thrombosis of the inferior cava,...

     
    Area of Interest: Veins / Vena cava; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Aneurysms;

    Coronal (f) and sagittal (g,h) reconstructions confirmed aneurysmal dilatation (*) of the right hypogastric vein without signs of thrombosis. No abnormal dilatation, compression or thrombosis of the inferior cava,...

     
    Area of Interest: Veins / Vena cava; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Aneurysms;

    Coronal (f) and sagittal (g,h) reconstructions confirmed aneurysmal dilatation (*) of the right hypogastric vein without signs of thrombosis. No abnormal dilatation, compression or thrombosis of the inferior cava,...

     
    Area of Interest: Veins / Vena cava; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Aneurysms;

    Several inguinal lymphadenopathies (thin arrows) were confirmed bilaterally, predominantly on the right side.

     
    Area of Interest: Veins / Vena cava; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Aneurysms;
     
     
  • Figure 3
    Colour Doppler ultrasound follow-up 4 months later
     

    The right hypogastric vein aneurysmal dilatation (calipers) showed unchanged shape and size, and appeared anechoic without signs of internal thrombosis.

     
    Area of Interest: Veins / Vena cava; Imaging Technique: Ultrasound-Colour Doppler; Procedure: Diagnostic procedure; Special Focus: Aneurysms;

    Venous flow signals were seen at colour Doppler scanning.

     
    Area of Interest: Veins / Vena cava; Imaging Technique: Ultrasound-Colour Doppler; Procedure: Diagnostic procedure; Special Focus: Aneurysms;
     
     
5 years earlier, longitudinal (a) and transverse (b,c) ultrasound images showed chronic deep venous thrombosis (T) of the right lower limb, from the popliteal to the common femoral vein.
 
5 years earlier, longitudinal (a) and transverse (b,c) ultrasound images showed chronic deep venous thrombosis (T) of the right lower limb, from the popliteal to the common femoral vein.
 
5 years earlier, longitudinal (a) and transverse (b,c) ultrasound images showed chronic deep venous thrombosis (T) of the right lower limb, from the popliteal to the common femoral vein.
 
Additional findings included several bilateral inguinal reactive adenopathies (thin arrows in d), and lymphedema of the subcutaneous fat (calipers in e) along the right thigh.
 
Additional findings included several bilateral inguinal reactive adenopathies (thin arrows in d), and lymphedema of the subcutaneous fat (calipers in e) along the right thigh.
 
Axial unenhanced images (a,b) showed a well-demarcated ovoid mass lesion (*) measuring 4.5x3 cm, with solid-type attenuation (30-35 Hounsfield units) abutting the right obturator muscle and compressing the urinary bladder (+).
 
Axial unenhanced images (a,b) showed a well-demarcated ovoid mass lesion (*) measuring 4.5x3 cm, with solid-type attenuation (30-35 Hounsfield units) abutting the right obturator muscle and compressing the urinary bladder (+).
 
The mass lesion (*) did not enhance in the arterial phase and did not appear to infiltrate adjacent structures. Note extrinsic compression on urinary bladder (+).
 
The venous phase acquisition (d-h) showed the lesion (*) to enhance homogeneously and synchronously with venous vessels, consistent with aneurysmal dilatation of the proximal hypogastric vein. Urinary bladder (+).
 
The venous phase acquisition (d-h) showed the lesion (*) to enhance homogeneously and synchronously with venous vessels, consistent with aneurysmal dilatation of the proximal hypogastric vein. Urinary bladder (+).
 
Coronal (f) and sagittal (g,h) reconstructions confirmed aneurysmal dilatation (*) of the right hypogastric vein without signs of thrombosis. No abnormal dilatation, compression or thrombosis of the inferior cava, common and external iliac veins.
 
Coronal (f) and sagittal (g,h) reconstructions confirmed aneurysmal dilatation (*) of the right hypogastric vein without signs of thrombosis. No abnormal dilatation, compression or thrombosis of the inferior cava, common and external iliac veins.
 
Coronal (f) and sagittal (g,h) reconstructions confirmed aneurysmal dilatation (*) of the right hypogastric vein without signs of thrombosis. No abnormal dilatation, compression or thrombosis of the inferior cava, common and external iliac veins.
 
Several inguinal lymphadenopathies (thin arrows) were confirmed bilaterally, predominantly on the right side.
 
The right hypogastric vein aneurysmal dilatation (calipers) showed unchanged shape and size, and appeared anechoic without signs of internal thrombosis.
 
Venous flow signals were seen at colour Doppler scanning.
 
 
 
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